STANFORD, Calif. — Gravity and sagging skin aren’t the only roadblocks to a perpetually youthful face. Aging facial bones may be just as guilty of the telltale signs of advancing years, according to new research from the Stanford University School of Medicine.

This “dramatic” aging of facial bones also happens at a significantly younger age for women than men.

“As the skin sags, the bony framework underneath the skin deteriorates as well, contributing to the development of new folds, creases, wrinkles, droops and valleys,” said David Kahn, MD, assistant professor of plastic and reconstructive surgery. Crow’s-feet, drooping brows, sagging facial folds—it’s not just skin deep.

Two studies by Kahn and Robert Shaw, MD, a resident at the University of Rochester Medical Center who was a medical student at Stanford when the research was conducted, document this problem. The second study is being presented Oct. 10 at the American Society of Plastic Surgeons yearly convention in San Francisco; the first was presented at the same conference last year and is scheduled for publication this winter.

In a way this is disturbing. Look at yourself in the mirror. It isn't just the soft stuff that is aging and thinning. Your facial bones are decaying while you are alive.

Today’s single-dimensional approach to facial rejuvenation, Kahn said, may explain the sometimes-negative results of plastic surgery to the face that can result in odd, distorted looks.

“After you do a face-lift on some patients and look at photos of them when they were young, they look very different,” said Shaw. “Part of that may be the tightening of the skin over a bony scaffolding that has deteriorated and changed in shape from when they were 18.”

There’s a change in morphology or shape to the bones as well as a general shrinkage, Shaw said.

Dr. 90210 can't turn back the clock all that much. We need better treatments that go deeper.

Women experience facial bone aging sooner than men.

For the two studies, the researchers analyzed 30 men and 30 women separately using advanced, three-dimensional, computerized reconstruction of the facial skeleton. The participants were separated into three different age groups identified as young (25 to 44), middle-aged (45 to 64) and old (65-plus). They then measured the various bony structures in the face—the slope of the cheekbone and the opening for the nose, for example—and compared these changes between age groups and genders.

“In general, for most of our measurements, women experienced aging between young and middle age, and the men between middle age and old,” Shaw said.

Specific changes to different bony structures in the face seem to correlate with the various well-known visible changes to the face due to aging, Kahn said. Changes to the orbital aperture, or bony area around the eye, for example, could account for crow’s-feet and the drooping of the skin above the eye.

Aging bones in the cheeks could be part of the cause of the deepening of the creases between the lips and the nose and could cause the fat pad in the cheeks to sag and become more prominent. Much of these changes may be due to decreasing bone support, Kahn said.

The earlier aging of facial bones in women than men parallels the earlier aging of skin in women than in men. What I find puzzling about this is that women live longer than men on average. In more essential parts of the body men wear out more rapidly than women do. What accounts for this pattern of differences in body aging between men and women? Is it due to selective pressures where since women lose fertility sooner than men they also lose the need to look physically attractive sooner than men lose that need?

Plastic surgeons can implant materials that will lift up the skin. But we really need stem cell and gene therapies that'll up the supply of healthy young osteoblast cells. The osteoblasts build up bone while the osteoclasts tear it down.

The aging process also reduces muscle mass and increases fat. So full rejuvenation of appearances will require rejuvenation of skin, collagen, cartilage chondrocyte cells, bone osteoblasts, muscles, capillaries, and likely other cell types and structures as well.

Strangely enough, the fact that aging appearances have so many causes is a reason to be optimistic about the rapid development of rejuvenation treatments. People are willing to spend big money on treatments to improve their appearances. Plastic surgery is a rapidly growing industry. Biotech companies are developing cell therapies to treat hair loss and other signs of aging. The identification of a greater list of causes of aging appearances translates into demand for a larger range of products to make people look young again. The greater demand will spur more development of appearance rejuvenation treatments. Some of the products developed to rejuvenate appearances (e.g. stem cell therapies to restore facial bones) will also reverse aging in the rest of the body.

Another thought on cost driven rejuvination. There is a strong cost argument for kidney regeneration. Health care is already on the hook for dialysis. A kidney rejuvination methods could rapidly be accepted if it is cheaper than dialysis.

Good point. Rejuvenation for any disease that lasts a long time and has a large continuing cost will yield a bigger cost savings.

The development of biotech to successfully grow replacement organs can't be more than 20 years off at this point. I doubt it is even 10 years off - at least for some organs. Some will be easier to grow than others. I'm expecting replacement livers before replacement kidneys because kidneys are 3 dimensionally a lot more complex. My guess is that replacement kidney growth requires replicating the environment that a developing kidney encounters. But I do not expect replication of such an environment to be necessary for liver replacement growth.

"The earlier aging of facial bones in women than men parallels the earlier aging of skin in women than in men. What I find puzzling about this is that women live longer than men on average. In more essential parts of the body men wear out more rapidly than women do. What accounts for this pattern of differences in body aging between men and women?"

The issue could be one of *accelerated* ageing in men, as opposed to retardation of ageing in women (possibly due to endocrinal differences)